suicide – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAThu, 24 May 2018 19:28:56 +0000en-UShourly1https://wordpress.org/?v=4.2.290498487Suicides Push Medical Schools to Finally Address Student Mental Healthhttps://ww2.kqed.org/futureofyou/2017/05/02/suicides-push-medical-schools-to-finally-address-student-mental-health/
Tue, 02 May 2017 18:04:11 +0000https://ww2.kqed.org/stateofhealth/?p=325604Last year, all of the accumulated data pointing to the poor mental health of medical students in general suddenly became more than just numbers at USC’s Keck School of Medicine.

A Keck student, 25-year-old Sean Petro, had failed to show up for a clinical rotation. Eventually, campus police found his body Read More …

]]>325604Talking is Easy for Therapists, Except When It’s About Guns. Veterans Want to Teach Them How.https://ww2.kqed.org/stateofhealth/2017/02/01/talking-is-easy-for-therapists-except-when-its-about-guns-veterans-want-to-teach-them-how/
https://ww2.kqed.org/stateofhealth/2017/02/01/talking-is-easy-for-therapists-except-when-its-about-guns-veterans-want-to-teach-them-how/#commentsWed, 01 Feb 2017 09:00:16 +0000http://ww2.kqed.org/stateofhealth/?p=274976Jay Zimmerman got his first BB gun when he was seven, and his first shotgun when he was ten.

“Growing up in Appalachia, you look forward to getting your first firearm probably more so than your first car,” he says.

His grandfather taught him to hunt squirrel and quail. Zimmerman, who lives in Tennessee, says pretty much everyone he knows has a gun. It’s just part of the culture.

“When I went into the military, that culture was reinforced,” he says. “Your weapon is almost another appendage. It’s part of who you are.”

Zimmerman was a medic in the army in the late 1990s and early 2000s. He served in Bosnia, Africa, and the Middle East. Since he came home, he’s struggled with PTSD and depression. It reached a crisis point a few years ago, when his best friend — the guy who had saved his life in a combat zone — killed himself. Zimmerman decided his time was up too.

“I decided that I would have one more birthday with my daughter, one more Christmas with my daughter,” he says. “I had devised my own exit strategy for sixteen February, 2013.”

But then he bumped into a woman who used to ride the same school bus when they were kids. His exit date came and went. They’re married now.

Zimmerman is a peer counselor at the Mountain Home VA Medical Center in Johnson City, Tennessee. He also travels to conferences all over the country, sharing his story with therapists and with other vets. He tries to set an example that it’s okay to ask for help. Even today, if he’s not doing well, he disassembles his guns and stores them separately from ammunition, so he can’t make any rash decisions. If things get really bad, Zimmerman has a special arrangement with a few friends.

“I call them and say, ‘Look, I’m feeling like it’s not safe for me to have firearms in my home. Can you store them for me for a couple days till I feel like I’m OK to have them back?'”

Jay Zimmerman (right) was an army medic. He poses with his dad before he deployed to Bosnia in 1998. (Photo Courtesy of Jay Zimmerman)

Suicide is an impulsive act. Nearly half the people who survive an attempt say the time between their first thought of suicide and the attempt itself was less than 10 minutes. But the method can mean the difference between life and death: people who take pills have time to change their minds. Not with guns.

About 70 percent of veterans who commit suicide do so with a gun, which prompted President Barack Obama to order the VA to talk to vets about gun safety and storage options like the ones Zimmerman uses.

But here’s the trouble: Most therapists aren’t gun people. They don’t know how to talk about guns. And so they don’t.

“One obvious reason for that is that no one has taught them how,” explained Megan McCarthy, National Deputy Director in the Office for Suicide Prevention at the Department of Veterans Affairs.

McCarthy was invited to speak recently at a suicide-prevention conference in San Francisco for therapists who work with vets.

“How many of you would say you feel really comfortable having a conversation with any of the people you work with about limiting access to all lethal means?” she asked the roomful of therapists.

Hardly anyone raised their hand.

“Okay, so that’s why we’re here today,” she said.

Researchers recommend starting with a field trip to a shooting range. There, therapists can learn about different kinds of firearms, as well as gun locks, and get an introduction to gun culture.

When counseling vets, therapists have to ask more questions and be less directive, according to McCarthy.

“We often conceive of ourselves as experts, as people who impart information to clients,” she said. But with vets, “it may take time to build trust. Telling them what to do the first time you’ve met them is probably not going to be a very effective approach.”

Therapists learn how to talk to vets about guns at a conference in San Francisco.

McCarthy presented a case study at the conference: A 28-year old army veteran who fought in Iraq told his VA psychiatrist that he had an argument with his girlfriend last week. He drove to an empty parking lot and sat with his loaded handgun in his lap, intending to kill himself.

He didn’t do it. A week later, the man told his psychiatrist things were still tense with his girlfriend. But he didn’t want to talk about suicide or storing his gun.

McCarthy asked the clinicians in the audience what they would do next, if they were this man’s psychiatrist.

“Why did he not do it? That would be my question,” said one therapist.

“I’d say, would you be willing to talk more about that?” said another.

“I would want to see this individual again, within the same week,” said a third. “I believe in strong intervention.”

Jay Zimmerman, the former army medic and peer counselor, stood up. He told them they’re all wrong.

“Chances are the reason he’s not talking to you is because he’s afraid he’s going to lose his gun, that he carries pretty much all the time,” he said. “My buddies are the same way, we all carry all the time.”

Zimmerman said the vet in the case study would rather talk to someone like him than someone in a white coat.

“If he’s got that good relationship with me as a peer, as a buddy, he’s probably already called me and talked to me,” he explained.

The takeaway for psychologists at the San Francisco conference, McCarthy said, is that sometimes their role is not to intervene, but to be a facilitator, someone who can connect vets with peer counselors like Zimmerman, or suggest they talk with a buddy, not always a professional.

]]>https://ww2.kqed.org/stateofhealth/2017/02/01/talking-is-easy-for-therapists-except-when-its-about-guns-veterans-want-to-teach-them-how/feed/3274976jay-zimmerman-in-uniform-and-dadJay Zimmerman right) was an army medic. He poses with his dad before he deployed to Bosnia in 1998.afsp-vaconference-audienceTherapists learn how to talk to vets about guns at a conference in San Francisco.Stopping Suicide, With Help From the Local Gun Shophttps://ww2.kqed.org/stateofhealth/2016/12/27/stopping-suicide-with-help-from-the-local-gun-shop/
https://ww2.kqed.org/stateofhealth/2016/12/27/stopping-suicide-with-help-from-the-local-gun-shop/#commentsTue, 27 Dec 2016 19:47:04 +0000http://ww2.kqed.org/stateofhealth/?p=275384Ralph Demicco was standing behind the counter at Riley’s Sport Shop in New Hampshire one Saturday morning when a woman walked in and came right up to the counter.

“Almost immediately she pointed to a firearm at the counter and said, ‘I’d like to buy that gun,’ ” Demicco remembers. “And that just sets off alarm bells.”

Most customers would browse, ask to see a few different models, ask questions.

“I said to her, ‘Ma’am, should you really be buying this gun?’ ” Demicco recalls now.

The woman started crying. Demicco took her into the back office to talk.

“She had been released from a mental health facility that morning,” he said. “Didn’t feel like she was ready to go.”

Demicco has lots of stories like this from his 40 years owning the gun shop. At one point, he got a call from a public health researcher who studies suicides. She told him that three people, over the course of a week, had bought firearms from his store and killed themselves.

“To say I was speechless is an understatement,” he says.

Demicco is skeptical of public health types, and worries they have hidden agendas. But after hearing about those suicides, he decided to join forces with the researchers to form the New Hampshire Firearms Safety Coalition. They developed a prevention campaign, but one that was rooted in gun culture.

Demicco traveled across New Hampshire and asked gun dealers to put up a poster in their stores. It shows two people, one of them clearly in distress, and the other lending a comforting hand. The message, Demicco says, was “Friends don’t let friends hurt themselves.”

It’s similar to the “Friends don’t let friends drive drunk” campaigns of the ’80s. The idea was to raise awareness of suicide risk factors among gun enthusiasts, so they could look out for one another.

“If Uncle Harry is getting a divorce and is distraught over it and he has firearms, you need to step up to the plate, you need to be the one,” Demicco says. “It’s OK to intervene.”

In the last several years since then, firearm clubs have partnered with health experts in 20 states to adopt the New Hampshire Firearms Safety Coalition’s campaign.

Shasta County Gun Shop Owners

Public health officials in Shasta County, in the far northern reaches of California, were among the first to approach gun shop owners for help. They say there are similarities in Shasta County with New Hampshire, when it comes to suicide trends and a pro-gun culture.

“We have a high number of firearm suicides,” says Katie Cassidy, who spearheaded the project for the county Health and Human Services Department in 2008. “We’re a very rural community, we have a lot of hunters. So taking a traditional approach, like ‘Wear your seatbelt,’ didn’t go over very well.”

Instead, the department took the New Hampshire approach and partnered with firearm dealers and law enforcement, asking them what kind of messaging would work, and asking them to review brochure drafts.

“As soon as we took the approach of curiosity, rather than coming into the discussion with an opinion,” Cassidy says, “that opened a lot of dialogue that hadn’t been at the table before.”

The Olde West Gun & Loan in Redding, California (April Dembosky)

At the Olde West Gun & Loan in Redding, some impressive stuffed deer heads and wild pigs line the walls. General manager Richard Howell demonstrates some of the merchandise responsible for these trophies.

“Bolt-action rifles, lever-action rifles, .22s,” he says, pointing to the rows of weapons in the case. He opens the port of a pump-action shotgun.

“Load it,” he says, closing the chamber, “take it out in the field, hunt.”

The local sheriff and health department are now asking shop owners like Howell to put some new versions of the brochures on their sales counters. Howell looks over a draft.

Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention. (April Dembosky)

Virtually all kids and new shooters learn about the 10 commandments of gun safety. The brochure boldly adds an 11th: knowing the signs of suicidal behavior and helping friends store their guns outside the home during an emotional crisis.

He’s not sure the “friends don’t let friends drive drunk” philosophy really works with guns. He says the difference is that driving is a privilege, while owning a gun is a right.

But Howell says he can understand why Shasta County is trying this. If the sheriff just wants him to leave a pile of brochures on the counter, it’s no problem. And if someone were to ask him to store a firearm at the shop, he would be OK with that.

“We wouldn’t be against that,” he says. “If someone takes a pamphlet home and it saves one life, then it’s done its job.”

]]>https://ww2.kqed.org/stateofhealth/2016/12/27/stopping-suicide-with-help-from-the-local-gun-shop/feed/8275384img_1723The Olde West Gun & Loan in Redding, Calif.img_2237Shasta County health officials, in collaboration with gun shop owners, developed a brochure to raise awareness around suicide prevention.Suicide Rates Climb In U.S., Especially Among Adolescent Girlshttps://ww2.kqed.org/stateofhealth/2016/04/25/suicide-rates-climb-in-u-s-especially-among-adolescent-girls/
Mon, 25 Apr 2016 21:37:12 +0000http://ww2.kqed.org/stateofhealth/?p=176688In the ’80s and ’90s, America’s suicide trend was headed in the right direction: down.

“It had been decreasing almost steadily since 1986, and then what happened is there was a turnaround,” says Sally Curtin, a statistician with the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Though they make up a very small portion of total suicides, the rate in girls ages 10-14 jumped the most, tripling over 15 years.

The suicide rate has risen by a quarter, to 13 per 100,000 people in 2014 from 10.5 in 1999, according to an analysis by Curtin and her colleagues that was released Friday.

She says it’s heartbreaking to work with these data. While other causes of death are on the decline, suicide just keeps climbing — and it’s doing so for every age group under 75.

“I’ve been losing sleep over this, quite honestly,” says Curtin. “You can’t just say it’s confined to one age group or another for males and females. Truly at all ages people are at risk for this, and our youngest have some of the highest percent increases.”

There is one age group that really stands out — girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over 15 years from 0.5 to 1.7 per 100,000 people.

And, Curtin points out, in any given year, there are a lot more suicide attempts than there are suicide deaths. “The deaths are but the tip of the iceberg,” she says.

Until the suicide trend reversed upward, there had been a number of improvements in the past few decades.

In the late ’80s, things were probably looking up partially due to new antidepressants that were more effective and had fewer side effects, says Dr. Maria Oquendo, a psychiatry professor at Columbia University Medical Center and president-elect of the American Psychiatric Association. “We saw this very encouraging decrease in suicide deaths,” she says, and the parallel between antidepressant prescription and a decline in suicide was mirrored in other countries. “It was really very remarkable, and somehow that trend toward decreasing suicide rates abruptly stopped in 1999.”

What changed? One possibility is economic stagnation, which left more people out of jobs and probably made it harder for people to access health care and treatment. There was also a switch from the use of cocaine and crack to use of heroin and prescription painkillers, which can be lethal in case of an overdose.

And there’s also the matter of health insurance — a lot of people weren’t covered or didn’t have access to treatment for depression, the most common risk factor for suicide. (Since 2014, however, the Affordable Care Act has led to a substantial increase in insurance coverage.)

“Now, the other thing that we were anticipating with some dread was the aftermath of the black box on antidepressants,” says Oquendo, referring to a warning label that in 2004 the Food and Drug Administration required for commonly prescribed antidepressants.

The label says that in people under age 26, the medications can actually increase the risk of suicidal thoughts and actions. Research has suggested that the warning scared doctors away from prescribing antidepressants to people of all ages.

“And some of the increment in suicide deaths in the younger populations is potentially linked to an understandable reluctance by physicians who see these youngsters to prescribe antidepressants, even when they’re aware that the individual is suffering from depression,” says Oquendo. Research has shown that the benefits of prescribing antidepressants to mentally ill children tend to outweigh the risk of suicidal tendencies.

But why such a sharp rise among adolescents, particularly girls? “We don’t know what’s going on, to be quite honest,” says Arielle Sheftall, who works at the Center for Suicide Prevention and Research at the Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. “We have thoughts, that maybe it’s this, maybe it’s that. It’s really hard to pinpoint one specific risk factor that really, truly is driving this trend.”

She and her colleagues study the risk factors that might push a depressed child or teen to attempt suicide. One hypothesis about what’s going on with girls is pretty surprising: earlier puberty.

“It’s usually been referred to as the storm-and-stress period of life because there’s just a lot of change happening all at one time,” says Sheftall.

Boys tend to hit peak puberty around 13 years old, and girls around 11 years old, though some studies show that girls are starting their periods earlier.

“Research has shown that puberty, unfortunately, is associated with the onset of psychological disorders, specifically depression,” says Sheftall.

And depression is a big risk factor for suicidal thoughts and actions. So, because of the shifting age of puberty onset, girls might be opening the door to anxiety, depression and other psychiatric disorders earlier on in life.

Sheftall and Oquendo say the hypothesis hasn’t been carefully studied, but it’s possible. Another potential factor is that girls attempting suicide could be using more lethal methods, resulting in more deaths.

“It’s frustrating because you want to never ever see these trends increase,” says Sheftall. “That’s what we kind of have dedicated our lives and research to: What is causing these increases to occur?”

For now, there are still more questions than answers.

If someone shows the warning signs of suicide: Do not leave the person alone, remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt, call the U.S. National Suicide Prevention Lifeline at 1-800-273-TALK (8255), and take the person to an emergency room or seek help from a medical or mental health professional.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

]]>176688Screen Shot 2016-04-25 at 2.27.51 PMAs Aging White Man, Robin Williams Was Particularly at Risk for Suicidehttps://ww2.kqed.org/stateofhealth/2014/08/13/as-aging-white-man-and-comic-robin-williams-was-particularly-at-risk-for-suicide/
https://ww2.kqed.org/stateofhealth/2014/08/13/as-aging-white-man-and-comic-robin-williams-was-particularly-at-risk-for-suicide/#commentsWed, 13 Aug 2014 21:39:51 +0000http://blogs.kqed.org/stateofhealth/?p=20712An Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’

You don’t really expect a professional baseball player to be the one person to articulate the effect Robin Williams had on much of the general public, but that was my feeling when I read this quote in today’s San Francisco Chronicle from Giants pitcher Tim Lincecum, who had once been thrilled to receive a congatulatory handshake from Williams. Said Lincecum:

“He made things feel like they weren’t so bad.”

Remembering some of Williams’ early manic groundbreaking appearances on television and movies, the statement rang true, as did the chilling irony in its description of a man who seemingly had everything but clearly thought that things were that bad, after all.

The suicide rate for white men increased almost 40 percent between 1999 and 2011.

Considering his suicide, it’s not surprising that Williams’ publicist said Monday that the comedian suffered from severe depression. Williams also struggled with substance abuse issues for decades. Since his death, a national conversation has ensued on the insidious effects of depression, and how it can prove fatal even in those who, to the outside world, seemingly have everything to live for.

Around the country, media organizations have been interviewing mental health experts on the subject. The Chronicle talked to some who worried about the impact of Williams’ suicide on those struggling with depression. “I get concerned about people wondering if people as promising as him with all these resources available can’t make it, what are the chances for them?” Patricia Arean, a UCSF clinical psychologist and psychiatry professor, told the paper.

She said many people who are depressed often can’t find their way to the appropriate treatment if what they’re currently doing to address their condition isn’t working.

“Unfortunately, what happens is that people don’t know enough about their own illness to know if they’re not getting better,” Arean said.

Dr. Winston Chung, medical director of inpatient psychiatry at California Pacific Medical Center, said there is still a stigma on those with mental health conditions. Discovering physical traces of mental illness, such as genetic traits and biological markers, could help reduce that stigma, he said.

“With cancer, you can see the cells under the microscope. In depression, you can’t see it,” Chung told the Chronicle. “There’s no broken bone, no radiological finding. We need to have concrete evidence, not unlike the cancer cell. Something we can see and reliably associate with mental health issues.”

A Risk: Aging White Men

The Washington Post writes that Williams belonged to a demographic with an especially high risk of suicide: older white men. …

If you tried to create a profile of someone at high risk of committing suicide, one likely example would look like this: A middle-aged or older white male toward the end of a successful career, who suffers from a serious medical problem as well as chronic depression and substance abuse, who recently completed treatment for either or both of those psychological conditions and who is going through a difficult period, personally or professionally.

Last year,the federal government reported the suicide rate for white men increased almost 40 percent between 1999 and 2011. And. because white men use more lethal methods, such as shooting themselves, they account for 80 percent of fatalities despite making up just 20 percent of attempts.

Another factor in the high suicide rate among older men: They are less likely to seek help, Older men may also be prone to reflecting negatively on what they have done with their lives, with an accompanying loss of self-esteem.

“Has the career been worth it, or did I sacrifice my family . . . I think that is part of what happens for people,” Nadine Kaslow, a psychology professor at the Emory University School of Medicine, told the Post.

Christopher Kilmartin, a psychology professor at the University of Mary Washington, said he often refers to aging males as “developmentally unsuccessful, because they’re not equipped to handle the challenges of getting older if they are so tied into their masculinity . . . and making a lot of money.”

Said Dost Ongur, associate professor of psychiatry at Harvard Medical School: “Things aren’t the way they used to be. The power you knew, the control you knew, aren’t the same.”

In 2010, Williams told fellow comedian Marc Maron, on Maron’s WTF podcast, that he had contemplated suicide in the past. When discussing what caused him to start drinking again in 2005, Williams told Maron, according to the L.A. Times, “It’s trying to fill the hole, and it’s fear. You’re going, ‘What am I doing in my career?’ You bottom out. … People say, ‘You have an Academy Award.’ The Academy Award lasted about a week, and then one week later people are going, ‘Hey, Mork!'”

Comics Prone to Depression

Comics are so prone to depression that the Laugh Factory, a comedy club in Los Angeles, started in-house therapy sessions in 2011. Owner Jamie Masada told the L.A .Times at the time, “This is serious. This is something we have to do. From Richard Jeni putting a gun in his mouth and blowing himself up [in 2007] to Greg Giraldo taking drugs and overdosing [in 2010], I just can’t stand to watch all of my family, one by one [self-destruct].

“From Sam Kinison to Rodney Dangerfield to Paul Rodriguez, Dom Irrera — every comic, they have a little demon in them.”

Clinical psychologist Ildiko L. Tabori told the Times that research indicated a “higher degree of depression and bipolar disorder in comedians.”

“Laughter is a defensive mechanism,” she said.” It’s one of the more mature defense mechanisms, but it still masks whatever it is that’s going on inside.”

Breel is just 20, but he’s already had to battle suicidal urges. Outwardly, he said, he hardly seemed like the type you would suspect would be depressed — he was a model student and athlete. “Depression isn’t chicken pox,” Breel said. “You don’t beat it once and then it’s gone forever. It’s something you live with. It’s something you live in. It’s the roommate you can’t kick out. It’s the voice you can’t ignore and the feelings you can’t seem to escape, and the scariest part is, the scariest part is that after awhile, you become numb to it.”

The Chronicle compiled this list of resources in the Bay Area for those who are undergoing a mental health crisis:

]]>https://ww2.kqed.org/stateofhealth/2014/08/13/as-aging-white-man-and-comic-robin-williams-was-particularly-at-risk-for-suicide/feed/420712robinwilliamsAn Instagram photo that comedian and actor Robin Williams posted on his last birthday, July 21. The caption: ‘Happy Birthday to me! A visit from one of my favorite leading ladies, Crystal.’State Seeks Return to Full Control over Prison System Mental Health Carehttps://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/
https://ww2.kqed.org/stateofhealth/2013/03/26/state-seeks-return-to-full-control-over-prison-system-mental-health-care/#respondTue, 26 Mar 2013 17:40:21 +0000http://blogs.kqed.org/stateofhealth/?p=11716By Julie Small, KPCC
Pelican Bay State Prison, Crescent City, CA. (Michael Montgomery/KQED)

More than a decade ago, a federal judge appointed a special master to oversee mental health care in the California state prison system. Since then, California has spent billions of dollars to improve psychiatric care for inmates. On Wednesday, the state will formally ask to have that oversight ended. But a high suicide rate among inmates is complicating the state’s petition.

Experts hired by the state and by the court say there are fundamental problems with how the Department of Corrections and Rehabilitation handles suicidal prisoners.

The experts say things go wrong as soon as an inmate is labeled suicidal. While waiting for a psychiatric assessment, the prisoner is placed in a holding cell the size of a telephone booth.

Despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up.

Jane Kahn, a lawyer who represent inmates in lawsuits against the prison system, says male prisoners are often stripped “and left just in their boxers.”

“The biggest concern is that prisoners will not report that they’re feeling suicidal if they’re held in these kind of settings,” Kahn adds. “We think it’s one of the many factors that explains this high rate of suicide within our system.”

And despite the billions spent overall on mental health care, the suicide rate in California’s prisons has been going up. Over the past 14 years an average of 31 prisoners a year have killed themselves -– a rate higher than the national averages for federal and state prisons as a whole.

Ask any psychiatrist who works in a California prison about suicide prevention, and he’ll tell you he follows a strict protocol: assess the inmate’s risk, move him to a cell where he can’t harm himself, send him for treatment, and closely monitor him throughout. But records show things don’t always work out that way. Dr. Alan Abrams recently retired from his job as chief psychiatrist at the California Medical Facility in Vacaville.

He described one case in particular.

“We had a patient who had every reason for suicide, severely depressed,” he said.

Abrams said staff sent the inmate to the acute care facility at the prison.

They said he was malingering, kicked him out without telling us, and he hung himself within 3 hours,” Abrams said.

That suicide seemed to be tied at least in part to bureaucratic bungling. But Kahn says that the high rate of suicide overall is a marker of how “bad the care is.”

In a court filing, the state’s corrections department said its system saves thousands of lives every year. Focusing on the handful of suicides distorts the overall picture, the state says.

But the court’s expert, Raymond Patterson, found the treatment of suicidal prisoners to be routinely deficient. Patterson said that in nearly half of the suicides last year, prison staff failed to assess the inmates for suicide risk or assessed them incorrectly.

The state accused Patterson of “second guessing and conjecture.”

Corrections Secretary Jeff Beard says it’s time for the federal court to end its oversight of the prisons’ mental health system.

“I’ve been around this system and visited over 20 institutions, and I can assure you there is not a deliberate indifference to the needs,” Beard said. “People are being identified; people are being properly placed, and people are given the level of care that they need.”

But the question remains: why has the rate of suicide in state prisons not fallen?

Terry Kupers, a forensic psychiatrist and prisons consultant, says California has gutted rehabilitation and education programs for inmates in recent years. He says prisons resorted to more lockdowns and isolation of inmates to deal with overcrowding and violence. Taken together, Kupers says, it can all lead to despair.

“In fact, a lot of the suicides that I’m asked to investigate will be of someone housed in solitary confinement,” Kupers says. “There will be on the record that they’ve been to the observation area three or four times, and they return to their cell — and that’s where they kill themselves.”

But former chief prison psychiatrist Alan Abrams says even if the state restored its education and rehabilitation programs, and had the best psychiatric care available, some prisoners would still kill themselves. Because, he says, not all suicidal inmates are mentally ill.

“People finally understanding that they’re going to spend the rest of their lives in prison and not wanting to. Who’s to say that it isn’t an acceptable solution to a failed life?” Abrams said.

After the state makes its case tomorrow, the federal judge is expected to rule within two weeks whether California is ready to once again assume sole control over mental health care in its prisons.